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Syndrome Zudeka - one of the complications of bone fracture
Last reviewed: 23.04.2024
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Injuries to the hands and feet is a common phenomenon, because with these limbs, a person performs the basic household and professional duties, moves and even protects the remaining parts of the body from damage. Bruising and fracture of the bone occur in both children and adults, and not always have beneficial effects. One of such negative consequences of limb injuries is Zudeck's syndrome, which leads to impaired limb functioning, and even disability.
What is Zudeck's syndrome?
The very name of this condition is associated with the name of the German surgeon, who first described this pathology on the border of the XIX-XX centuries. Then the pathology was still called "reflex sympathetic dystrophy", sometimes it was also called posttraumatic dystrophy of the hand. In 1996, the states united by the common name "Zudek syndrome" were proposed to be called CRPS, which stands for complex regional pain syndrome, which can be considered one of the types of pain syndrome.
Whatever it was, and pleasant in the syndrome Zudeka little, because the main symptom is pain in the area of damage, accompanied by impaired cellular nutrition of tissues, vasomotor disorders, fragility of bone tissue.
According to etiological research, despite the fact that dystrophic changes in the limbs are common to many diseases of the hands and feet, Zudek's syndrome is most often diagnosed with a fracture of the radius of the arm (62%), less often (about 30%), this condition occurs after a fracture of the leg bones. Only 8% of cases were noted when RSD was diagnosed against the background of a fracture of the humerus.
Causes of the syndrome of Zudeck
The fracture of the radial, ulnar or humerus bone is not the cause of Zudeck's syndrome. In most cases, such traumas are successfully treated without any consequences, and after a certain period of recovery the person can start working again.
Another thing is, if proper treatment has not been done, no qualified assistance has been provided or rehabilitation procedures have been incorrectly carried out.
To the reasons for the development of the syndrome Zudek can be attributed to improper actions in creating limb immobility, too tight bandage, causing swelling and numbness, painful procedures, early removal of gypsum and active hand movements in the first days after liberation from plaster bandages, non-compliance with the recommendations of the treating doctor.
Another reason for RSD lies in the incorrect diagnosis, when a fracture is taken as a banal bruise or sprain.
Incorrect medical massage or lack thereof, hot procedures in the first days after removal of gypsum can not only cause severe pain in the affected area, but also bring the process into a chronic form, which is difficult to treat.
Sometimes the causes of Syndrome Zudek are not related to the underlying disease, but are echoes of hormonal disorders, vegetovascular and cancer diseases. Identify them is much more difficult than the above.
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Pathogenesis
Many studies have confirmed that the fundamental role in the development of Zudeck's syndrome is assigned to the autonomic nervous system (VNS), under the control of which the work of internal organs and glands is located, in fact all internal processes, as well as adaptation of a person to various conditions of life. In this regard, there are violations of blood circulation at the site of injury, oxygen starvation of tissues, severe pain.
Degenerative processes prevail, and tissue repair is slow. This leads to a proliferation of connective tissue and an additional irritation of the sympathetic nerve. Over time, the bone system is drawn into the process, in which stagnant phenomena are observed leading to bone tissue atrophy, bone fragility, hardening of the joints and impairment of their mobility.
Violation of vegetative centers leads to a change in the work of endocrine glands and the activity of tissue hormones. There is a hormonal imbalance, which in women is manifested in the form of a lack of estrogens in the blood.
The development of Zudeck's syndrome after trauma is facilitated by nervous overstrain and stressful situations on the eve of a trauma.
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Symptoms of the syndrome of Zudeck
A syndrome is a combination of some symptoms that characterize a particular condition. With Syndrome, such symptoms are:
- The reddening of the skin due to overflow of blood vessels,
- noticeable edema of tissues,
- the appearance of heat in the damaged area,
- a strong pain that becomes stronger with any movement of the limb, and it does not disappear even when the limb is immobile,
- restriction of the motor activity of the joint and the limb as a whole.
These symptoms can be considered the first signs of the development of posttraumatic dystrophy, characteristic of the first stage of development of the pathological condition. They should alert both the patient and the treating doctor, who must prescribe procedures that block the manifestations of pain and inflammation.
Most often, patients do not attach importance to such manifestations, mistakenly considering them a natural reaction of the body to tissue damage, and the disease continues to progress, passing to the second stage with more severe symptoms.
In the second stage of Zudeck's syndrome, the skin color changes from red to bluish or violet. Edema becomes more dense and extensive. There are spasms and cramps in the muscles due to increased tone. The body temperature in the affected area is markedly reduced, the skin becomes cold (marbled skin). Over time, the skin becomes thin, smooth and shiny. Noticeable atrophy of muscles and subcutaneous tissue, nails and hair become more fragile. An X-ray image shows foci with low bone density (spotted osteoporosis).
Complications and consequences
If pathology does not begin to be treated at stages 1 and 2, serious complications can occur that lead to impaired motor function of the hand.
The third stage of the syndrome suggests that the process takes on a chronic form, in which there is a noticeable decrease in the size of the limb, caused by muscle and skin atrophy, as a result of which the bone tissue also loses its density. The pain becomes very strong, which prevents the limb from actively moving. In the end, this leads to a complete loss of mobility of the hand.
The consequences of the third stage of the Zudeck syndrome are more than unpleasant. The chronic course of the disease is difficult to treat. Cases of complete cure at this stage are rather an exception than the norm. Typically, such patients face disability.
Diagnostics of the syndrome of Zudeck
Correct and timely diagnosis, and, accordingly, timely treatment started will help prevent the occurrence of dangerous consequences of Zudeck's syndrome. And this means that the patient should not hide from the doctor the presence of disturbing sensations. If the redness and swelling of the skin doctor will notice during the examination, the patient should tell about the pain sensations himself.
If symptoms are not expressed, additional research may be necessary with the help of special equipment. At the same time, instrumental diagnostics helps not only to diagnose correctly, but also to determine the stage of development of pathology.
Radiography of damaged bone is the main method of investigation. It helps to identify osteoporosis of the bone and pathological processes preceding the development of immobility in the joints, which makes it possible to determine the development of Zudec's syndrome with a high probability.
Sometimes in the diagnosis of RSD resort to the help of a thermal imager, a device that determines the stage of the disease by the temperature difference of different tissues.
Ultrasound diagnosis (ultrasound) helps to determine the condition of blood vessels at the site of injury, which helps to clarify the diagnosis and adjust the treatment.
Differential diagnosis
The final diagnosis is made by the doctor on the basis of differential diagnosis based on the results of the prescribed studies, examination of the patient, taking into account his complaints. This is very important, because an incorrect diagnosis is an ineffective treatment plus lost time, which can lead to unpredictable consequences, in particular, to disability. The doctor also faces additional legal proceedings and may be deprived of a license for medical work.
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Treatment of the syndrome of Zudeck
As usual, the sooner the treatment is started, the more favorable will be its outcome. The first and second stages of the Zudeck syndrome do not cause any special difficulties in treatment, and allow us to quickly stop the pain and prevent the emergence of other symptoms.
Treatment of Syndrome Zudeck is carried out conservative methods. Operative intervention, as a rule, is not required. Methods and means are selected taking into account the stage of development of the pathological process, the characteristics of the organism and the state of the patient's health.
First of all, drug therapy is carried out, including analgesics for pain relief (Analgin, Ketanov, Ketorol, Diclofenac, etc.), vasodilator drugs, muscle relaxants for muscle relaxation, vitamins (mainly group B), anabolics, accelerating bone growth, an increase muscle mass and improving the general condition of patients.
Sometimes a psychologist needs help, as well as additional therapy with corticosteroids, antidepressants and antipsychotics, which the doctor individually appoints in each case.
Along with medication, physiotherapy is provided, such as acupuncture, barotherapy, therapeutic and relaxing massage, cryo-and laser therapy. It is mandatory to perform exercise exercises under the guidance of a specialist. This includes underwater gymnastics, and occupational therapy, and special games.
You can not limit the movement of the hand in everyday life, doing the usual actions with less intensity, even if there are certain painful sensations.
In severe cases, when the above methods and means do not give the desired result, surgical intervention is practiced. This can be as an introduction to the nerve of novocaine drugs and infiltration anesthesia, as well as sympathectomy, gradual stretching of the affected area, arthrodesis of the joints, osteotomy of the radial bone, and the like.
Medications for Zudeck's Syndrome
The initial stage of Zudeck's syndrome does not require the use of special medications. It is usually enough to relieve the pain syndrome. One of the popular drugs used for this purpose is Ketorol.
In addition to anesthetic action , Ketorol has a noticeable antipyretic and anti-inflammatory effect, which is important for a syndrome characterized by swelling and local fever.
Usually Syndrome Zudeka is characterized by severe pain syndrome. To remove it, you may need from 1 to 4 tablets (the maximum dose) per day, but do not abuse the drug. Taking more pills can cause an overdose with abnormalities of the digestive tract and kidneys.
Contraindications for the use of the drug include intolerance to acetylsalicylic acid and other non-steroidal anti-inflammatory drugs, erosive changes and inflammatory diseases of the digestive tract, various types of bleeding. As well as blood clotting disorders, heart failure at the stage of exacerbation, impaired liver and kidney function, excess potassium in the body, lactase deficiency, pregnancy and breastfeeding periods, age younger than 16 years, hypersensitivity to ketorolac (active substance).
Side effects: disorders of the gastrointestinal tract, accompanied by pain, headache and drowsiness, rashes on the skin, swollen reactions. Rarely failures in the work of the kidneys, ringing in the ears, shortness of breath, runny nose, anaphylactic reactions.
With severe pain and ulcerative lesions of the gastrointestinal tract, the drug in tablets can be replaced with injections, the action of which is much faster and safer. "Ketorol" is also available in the form of a gel that can be used as an external remedy for Zudek's syndrome.
Precautionary measures. Do not use in parallel with the intake of other NVPs. The therapeutic course should not exceed 5 days.
In the second stage of Zudek's syndrome, vasodilator drugs may be needed, including Papaverine, Trental, Cavinton, and Drotaverin.
"Drotaverin" - a budgetary spasmolytics of wide application, which has a fairly long-term effect. It lowers the tone of spasmodic muscles, thereby relieving pain and restoring the motor activity of the limb.
Method of application and dosage. A single dose for an adult patient is 1-2 tablets, which are recommended 2-3 times a day (maximum 6 tablets per day). For children from 3 to 12 years is enough 1/2 -1 tablets for 2 admission. Tablets should be taken whole, not crushing, squeezed with water. The intake of tablets does not depend on the intake of food.
Sometimes it is more appropriate to use "Drotaverin" in the form of a solution for injections. The adult dose is 2-4 ml. The drug is administered intramuscularly up to 3 times a day.
The drug has few side effects, and yet sometimes there is dizziness, increased heart rate, lower blood pressure, abnormalities of the digestive tract, allergic reactions.
Precautionary measures. Do not exceed the recommended dose of the drug, since an overdose can cause heart disorders, paralysis of the respiratory center and even cardiac arrest.
The drug is not taken with hepatic and renal failure, low blood pressure, breastfeeding, prostate adenoma, zakratougolnoy glaucoma, hypersensitivity to the drug. Do not use to treat children under 3 years old.
They help to relax the muscle tissue, removing the pain syndrome caused by its spasm, and preparations from the muscle relaxants.
"Methocaramol" is a muscle relaxant whose action is to block painful nerve impulses coming from the periphery into the brain.
To remove muscle spasms, the drug is used in a dosage of 1.5 g 4 times a day. After 2-3 days, the dosage is changed to 4-4.5 g, which must be divided into 3-6 receptions.
If there is no possibility to take the drug orally, it is administered as intramuscular or intravenous injections 3 times a day for 1 g. The course of treatment is 3 days.
Among the side effects of the drug is worth mentioning digestive and stool disorders, discoloration of urine, dizziness, nasal congestion, eye irritation, itchy skin rashes, weakening of the heartbeat. Sometimes there is redness of the skin, pain in the head, a taste of metal in the mouth, impaired vision, etc.
Precautionary measures. It is not necessary to apply the drug to patients who have a history of epileptic seizures, since the drug can provoke a second attack.
The drug is not used in pediatrics, except in cases of tetanus, and for the treatment of women during pregnancy and lactation.
It can influence the reaction speed, so do not use it in the case of work that requires concentration.
The use of anabolic in Zudeck's syndrome contributes not only to rapid bone splicing, but also to improving their nutrition and overall condition, increasing bone density. The latter is achieved by the introduction of drugs containing calcium and vitamin D (fish oil, "Calcemin", "Calcetrin", "Calcium D3 Nycomed", etc.) into the body.
Sometimes anabolics are used to stimulate the immune system in terms of enhancing regenerative processes in tissues, restoring metabolism in cells. In this way, it is possible to compensate for degenerative processes occurring in the extremities at an accelerated tempo with RSD.
"Timalin" is a preparation with immunostimulating action and providing the above-described effect. The preparation is based on the thymus extract of cattle. The drug is sold as a powder for intramuscular injections, which is diluted in saline solution.
The drug is designed to treat both adults and children. Toddlers are given 1 g each year, children from 1 to 3 years are prescribed 1-2 mg of the drug, children up to 6 years can be pricked with 2-3 mg of the drug. Patients older than 7 years receive a child dose of 3-5 mg, and older than 14 - an adult dose of 5-20 mg. The therapeutic course for an adult patient is 30 to 100 mg.
Duration of treatment can vary from 3 to 10 days depending on how strongly the symptoms of the disease are expressed.
Taking the drug does not cause other side effects, except for allergic reactions caused by hypersensitivity to the components of the drug. Cases of overdose during treatment "Timalin" was not observed. However, the drug is available only on prescription.
Zudeck's Alternative Treatment
Nobody says that alternative treatment of RSD does not make sense, but resorting to alternative medicine methods one must understand that they will be effective only at the early stage of the syndrome, when degenerative changes in the limb are not yet observed. At the same time, it will be incorrect to replace qualified medical care with alternative treatment. Thus, it is possible to lose precious time and miss the moment when deterioration of the limb can still be prevented.
Nevertheless, as alternative therapy to help improve the patient's condition, alternative prescriptions have the right to exist and can be successfully used in Zudek's syndrome.
For example, such a tool as an infusion from the usual green spices of dill and parsley can not only reduce pain, but also strengthen the bones with RSD.
Only fresh plants are used for the preparation of the infusion. 200 g of parsley leaves and the same amount of dill washed, boiled water and placed on the bottom of a liter jar. In a jar, add 0.5 liters of boiled hot water (not boiling water!) And insist the mixture for 3 hours, then filter.
Take infusion is necessary during meals three times a day for 100 ml for 6 months. The remnants of the infusion are poured out, daily preparing a new one.
Onions - another regular in the kitchen, which can be useful for the treatment of Zudeck's syndrome. To this end, prepare a decoction of fried onions.
2 medium-sized bulbs cut with rings and husk and fry in lean oil until golden. At this time, boil the water, put the onion in it and boil the broth for a quarter of an hour. Leave to insist for half an hour.
Then the resulting broth is divided into 3 equal parts, which are drunk in 3 days, after which a new broth is prepared. Such treatment lasts a month.
Outwardly, you can use a compress made from birch buds. For its preparation birch kidneys insist on vodka for 7 days, after which the compound is used for compresses for the night, additionally wrapped in the limb. Therapeutic course - 2 weeks.
For compresses and lotions, you can also use decoctions and tinctures of medicinal herbs, such as chamomile, sweet clover, St. John's wort, comfrey. Suitable for this purpose are walnut leaves.
Herbal treatment is the primary direction of alternative medicine, and the external application of herbal remedies as lotions and compresses is one of the safest methods of treating diseases.
And such a known herb as St. John's wort with Zudeck's syndrome can be used as a decoction both as an external remedy and as a means for oral administration. This broth is an excellent therapeutic and prophylactic.
Along with the decoction, the infusion of St. John's wort is used, for the preparation of which 1 tbsp. L. Dry grass is brewed with a glass of boiling water, after which it is insisted for 40-45 minutes.
Infusion needs to be cooked daily, and yesterday's disposal. Drink the infusion 3 times a day on a tablespoon, after it was filtered. The liquid must be at room temperature.
Homeopathic remedies for Zudeck's syndrome
Since treatment with Zudek syndrome is usually quite long (up to six months), in order to protect the body from the receipt of a large number of chemicals in the medicinal products used in traditional medicine, many patients and even doctors resort to the help of homeopathy. After all, among a wide selection of homeopathic preparations, of course, you can find some that will help relieve spasms and pain, improve the bone health and the general condition of patients diagnosed with RSD.
Pain caused by muscular spasms, typical of Zudeck's syndrome, shows drugs that have analgesic, spasmolytic and calming effects (Payne, Sparkuprel, Gelarium Hypericum).
"Payne" is a homeopathic remedy for relieving pain caused by muscle spasms and nerve pincers. It has practically no contraindications to the use and side effects, except for allergic reactions against a background of hypersensitivity to the drug.
Method of application and dosage. The tablets are placed under the tongue and held there until completely dissolved. Take 1 tablet with an interval of 10-20 minutes, until there is relief. Then the interval between doses is increased to 1-2 hours until the pain syndrome disappears completely.
Further treatment follows the pattern: 1 tablet 4 times a day.
Dosage for children is half that of adults.
Tablets should be taken 20-30 minutes before eating and drinking. It is impossible at this time to conduct and treatment and hygiene procedures in the oral cavity, so as not to reduce the effectiveness of the drug.
"Sparkuprel", being a natural antispasmodic, is designed to relieve spasms of skeletal muscles, which is necessary for Zudek's syndrome. The drug as a whole is safe for children and adults who do not have an increased sensitivity to its components, perfectly combined with other medicines of both traditional and traditional medicine.
Take the drug is recommended 3 times a day before eating 1 tablet, which must be absorbed until it dissolves completely. With sensitive severe spasms, you can take 1 tablet every quarter of an hour. And so for 1-2 hours.
"Gelarium Hypericum," it is an extract of St. John's wort known from prescriptions of alternative medicine, has a soothing and easy analgesic effect, having a positive effect on the condition of patients with RSD.
To avoid side effects, it is not used for hypersensitivity to the drug and sunlight, as well as for the treatment of patients younger than 12 years. It is undesirable to use during pregnancy and lactation.
The homeopathic extract of St. John's wort is available in the form of dragees, which take 1 piece 3 times a day for 4 weeks without chewing. You can drink it with water.
Precautionary measures. It is not used in parallel with antidepressants - MAO inhibitors. The interval between these medications should be at least 2 weeks.
Patients with diabetes may need a dose adjustment.
To improve bone splicing and the condition of bone tissue, Calcium phosphoricum, Acidum phosphoricum, Calcium carbonicum, Hepar sulfuris, Silicea, Phosphorus, fluoride salts, saturating the tissues with the necessary trace elements are used: calcium, fluorine , phosphorus, silicon.
Syndrome Zudeka is one of the indications for the use of the homeopathic preparation "Kalkkohel", which replenishes calcium deficiency in the body. It is designed to treat patients older than 6 years and is not suitable for those with lactose intolerance or lactase deficiency. Use during pregnancy and lactation only according to the doctor's indications.
Small patients who are not yet 12 years old are advised to take 1 tablet twice a day, children over 12 years and adults - three times a day. Tablets should be kept under the tongue until they dissolve completely. For patients with diabetes, the dose is adjusted by the doctor.
The intake of tablets should be delineated in time with meals (half an hour before meals or an hour after meals).
Usually, the therapeutic course lasts about a month, but in some cases a longer treatment (up to six months) is required.
Keep the drug in tightly closed containers to avoid reducing the effectiveness of homeopathic remedies.
Prevention
Effective preventive measures to protect themselves from the development of Zudeck's syndrome have not yet been developed by medical specialists. So readers can be advised only to protect their limbs from injuries, and if an unpleasant event happens, take a closer look at your condition and report all the unpleasant sensations to the doctor so that the treatment of the syndrome begins already at the initial stage of development.
Do not treat injuries as temporary discomfort, which itself will pass. Syndrome Zudeka in the first stage can generally manifest itself only superficially, without pronounced symptoms, so it gives the impression that there is no fracture at all. This is confusing some patients, and they do not turn in time for help, losing valuable time.
During the rehabilitation, some caution is needed. No matter how much you want to get up to speed and live a full life, you need to show patience and accuracy. Strong load on the damaged limb, sharp and active movements, weight lifting can provoke a pain syndrome, characteristic for the Syndrome of Zudek, and cause certain complications. The same effect is observed after thermal procedures and intensive massage with coarse actions.
To avoid severe pain during the treatment of the limb should be given a comfortable position. In the daytime, the hand should be fixed so that the brush is at the chest level, and at night it should be raised high above the pillow.
Occupations of physiotherapy exercises should be supervised by a specialist doctor who can always adjust the classes so that they bring the maximum benefit and do no harm. With this diagnosis, sanatorium treatment with radon baths and courses of gravitational therapy are also useful.
Forecast
The prognosis of the disease depends on the degree of its development. The Zudeck syndrome that has begun is already very difficult to stop. At the same time, its development occurs within 6 months, which is also responsible for the significant duration of treatment. During this period, the doctor has one task - to maintain or restore the motor activity of the hand and fingers, as well as to prevent the spread of the process above the damaged area.
The earlier the patient turned for help, the easier it is for a doctor to perform the task assigned to him. In the first days and weeks of development of painful pathology (stages 1 and 2), when the tissues do not yet undergo irreversible changes, the prognosis in most cases remains favorable. Usually within 6-12 months all limb functions are restored completely or partially.
At 3 stages of the RSD, the outlook is disappointing. Disability in Zudek's syndrome occurs for the most part precisely at this stage. In this case, the mobility of the joints is disrupted, there is an increased brittleness of the bones, an inconsistency in the size of the limbs. A person becomes unable to perform the usual actions by a damaged arm, which limits his ability to work (usually group II disability).
From all that has been said above, it is clear that the prevention of terrible consequences in the form of disability is primarily in the hands of the patients themselves. Competence and professionalism of the doctor are factors that influence the effectiveness of RNC treatment in the second turn. And only with the joint and timely efforts of the doctor and patient such a bone fracture complication, as Zudek's syndrome, manages to win completely.
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